Appeals court upholds MCHCP's denial of benefits

Appeals court upholds MCHCP's denial of benefits

Survivors of Missouri Consolidated Health Care Plan's retired beneficiaries cannot be covered by the plan after the beneficiary dies — unless they joined the plan at the time the beneficiary first retired.

That was the ruling Tuesday from a three-judge appeals court panel in Kansas City, upholding last year's ruling by Cole County Circuit Judge Jon Beetem.

Janice Spurgeon, of Owensville, sued the state health care agency in 2014 after its Board of Trustees denied her request to be added to the plan after her husband died in March 2014.

Her husband, Gary Spurgeon, had worked for Missouri's Division of Alcohol and Tobacco Control for nearly 34 years — until he retired Dec. 1, 2009.

Court records indicate he elected to continue his MCHCP health care benefits in his retirement — but he did not choose to have Janice added to that policy when he retired.

At the time — and continuing through the two sets of court trials and appeals hearings — she was covered by a health care policy through her employer, Crawford Electric Cooperative.

Janice Spurgeon's attorney — Joe Page, of Jefferson City — said Tuesday he doesn't expect she will appeal the case to the Missouri Supreme Court.

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That first appeals court ruling also noted MCHCP had argued "its decision to deny Spurgeon's application to enroll in the plan was lawful under its interpretation" of the law, and of a board regulation "that a retiree's survivors may elect to continue MCHCP coverage only if the survivors had MCHCP coverage at the time of the retiree's death."

However, the 2016 appeals court ruling specifically noted it wasn't "offering any opinion on the merits of (those) arguments."

After holding a new hearing in October 2016 and considering both sides' written arguments, Beetem last May ruled MCHCP had "acted in accordance with the law in denying (Spurgeon's) enrollment."

In his May 2017 ruling, Beetem said the MCHCP's regulations — part of Missouri's Code of State Regulations — clearly states: "At the time of a retiree or terminated vested subscriber's death, his/her survivor(s) may elect to continue coverage if the survivor(s) had MCHCP coverage at the time of the subscriber's death."

Beetem wrote last year, "She was covered under her employer's health insurance plan. Accordingly, there was no MCHCP coverage for her to continue. For this reason, MCHCP denied Mrs. Spurgeon's application. MCHCP's decision is not only reasonable, but is required by law."

In its 10-page ruling Tuesday, the appeals court said: "Gary (Spurgeon) had the opportunity to elect MCHCP coverage for (Janice) Spurgeon at the time of his retirement, based on Spurgeon's prior six months of coverage through her own employer.

"Gary was required to make an election at that time pursuant to (the state law). He chose not enroll Spurgeon at that time and, consequently, Spurgeon had no MCHCP coverage she could elect to continue at the time of Gary's death."